Medicare Beneficiary Assistance Improvement Act - Renames the benefit programs for lower income Medicare beneficiaries under title XIX (Medicaid) of the Social Security Act (SSA), commonly referred to as the "qualified Medicare beneficiary (QMB) program" and the "special low-income Medicare beneficiary (SLMB) program," as the Medicare Savings Programs.
Amends SSA title XIX with respect to Medicare Savings Programs to: (1) increase the SLMB eligibility income level from 120% to 135% of the poverty line; (2) deem to be qualified Medicare beneficiaries in certain states individuals already receiving benefits under SSA title XVI (Supplemental Security Income) (SSI); (3) permit individual self-certification of income and use of a simplified QMB or SLMB application form; (4) provide for automatic reenrollment; (5) direct the Commissioner of Social Security to provide for QMB and SLMB outreach through local offices of the Social Security Administration; (6) eliminate the assets test; (7) prohibit estate recovery under QMB and SLMB; and (8) provide for three months retroactive eligibility with respect to Medicare cost-sharing for QMBs.
Directs the Secretary of Health and Human Services (Secretary), the Secretary of the Treasury, and the Administrator of Social Security to arrange for a demonstration project to identify Medicare beneficiaries who are likely, based on Internal Revenue Service (IRS) data, to qualify for benefits under the QMB or SLMB programs, or to be entitled to a premium or cost-sharing subsidy for low-income individuals under the Medicare prescription drug program. Requires the Secretary to enter into a demonstration project to provide states with funds to use such information to do ex parte determinations or utilize other methods for identifying and enrolling potentially eligible individuals.
Requires the Commissioner of Social Security to send a notice and application for Medicaid benefits to individuals identified as likely to be eligible for QMB or SLMB benefits, or entitled to a premium and cost-sharing subsidy for low-income individuals under the Medicare prescription drug program, when notifying them of their eligibility for Medicare benefits.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3980 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 3980
To amend title XIX of the Social Security Act to improve the qualified
Medicare beneficiary (QMB) and specified low-income Medicare
beneficiary (SLMB) programs within the Medicaid Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 6, 2005
Mr. Dingell (for himself, Mr. Brown of Ohio, Mr. Waxman, Mrs. Capps,
Mr. Pallone, Mr. Boucher, and Ms. Baldwin) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to improve the qualified
Medicare beneficiary (QMB) and specified low-income Medicare
beneficiary (SLMB) programs within the Medicaid Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare
Beneficiary Assistance Improvement Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Renaming program to eliminate confusion.
Sec. 3. Expanding protections by increasing SLMB eligibility income
level to 135 percent of poverty.
Sec. 4. Eliminating barriers to enrollment.
Sec. 5. Elimination of asset test.
Sec. 6. Improving assistance with out-of-pocket costs.
Sec. 7. Improving program information and coordination with State,
local, and other partners.
Sec. 8. Notices to certain new medicare beneficiaries.
SEC. 2. RENAMING PROGRAM TO ELIMINATE CONFUSION.
The programs of benefits for lower income medicare beneficiaries
provided under section 1902(a)(10)(E) of the Social Security Act (42
U.S.C. 1396a(a)(10)(E)) shall be known as the ``Medicare Savings
Programs''.
SEC. 3. EXPANDING PROTECTIONS BY INCREASING SLMB ELIGIBILITY INCOME
LEVEL TO 135 PERCENT OF POVERTY.
(a) In General.--Section 1902(a)(10)(E)(iii) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(E)(iii)) is amended by striking ``120
percent in 1995 and years thereafter'' and inserting ``120 percent in
1995 through 2005 and 135 percent in 2006 and years thereafter''.
(b) Conforming Removal of QI-1 Provisions.--
(1) Section 1902(a)(10)(E) of such Act (42 U.S.C.
1396a(a)(10)(E)) is further amended--
(A) by adding ``and'' at the end of clause (ii);
(B) by striking ``and'' at the end of clause (iii);
and
(C) by striking clause (iv).
(2) Section 1933 of such Act (42 U.S.C. 1396u-3) is
repealed.
(3) The amendments made by this subsection shall take
effect as of January 1, 2006.
(c) Application of CHIP Enhanced Matching Rate for SLMB
Assistance.--
(1) In general.--Section 1905(b)(4) of such Act (42 U.S.C.
1396d(b)(4)) is amended by inserting ``or section
1902(a)(10)(E)(iii)'' after ``section
1902(a)(10)(A)(ii)(XVIII)''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to medical assistance for medicare cost-sharing for
months beginning with January 2006.
SEC. 4. ELIMINATING BARRIERS TO ENROLLMENT.
(a) Automatic Eligibility for SSI Recipients in 209(b) States and
SSI Criteria States.--Section 1905(p) of the Social Security Act (42
U.S.C. 1396d(p)) is amended--
(1) by redesignating paragraph (6) as paragraph (11); and
(2) by adding at the end the following new paragraph:
``(6) In the case of a State which has elected treatment under
section 1902(f) for aged, blind, and disabled individuals, individuals
with respect to whom supplemental security income payments are being
paid under title XVI are deemed for purposes of this title to be
qualified medicare beneficiaries.''.
(b) Self-Certification of Income.--Section 1905(p) of the Social
Security Act (42 U.S.C. 1396d(p)), as amended by subsection (a), is
amended by inserting after paragraph (6) the following new paragraph:
``(7) In determining whether an individual is a qualified medicare
beneficiary or is eligible for benefits under section
1902(a)(10)(E)(iii), the State shall permit individuals to qualify on
the basis of self-certifications of income without the need to provide
additional documentation.''.
(c) Automatic Reenrollment Without Need to Reapply.--
(1) In general.--Section 1905(p) of the Social Security Act
(42 U.S.C. 1396d(p)), as amended by subsections (a) and (b), is
amended by inserting after paragraph (7) the following new
paragraph:
``(8) In the case of an individual who has been determined to be a
qualified medicare beneficiary or eligible for benefits under section
1902(a)(10)(E)(iii), the individual shall be deemed to continue to be
so qualified or eligible without the need for any annual or periodic
application unless and until the individual notifies the State that the
individual's eligibility conditions have changed so that the individual
is no longer so qualified or eligible.''.
(2) Conforming amendment.--Section 1902(e)(8) of the Social
Security Act (42 U.S.C. 1396a(e)(8)) is amended by striking the
second sentence.
(d) Use of Simplified Application Process.--Section 1905(p) of the
Social Security Act (42 U.S.C. 1396d(p)), as amended by subsections
(a), (b), and (c), is amended by inserting after paragraph (8) the
following new paragraph:
``(9) A State shall permit individuals to apply to qualify as a
qualified medicare beneficiary or for eligibility for benefits under
section 1902(a)(10)(E)(iii) through the use of the simplified
application form developed under section 1905(p)(5)(A) and shall permit
such an application to be made over the telephone or by mail, without
the need for an interview in person by the applicant or a
representative of the applicant.''.
(e) Role of Social Security Offices.--
(1) Enrollment and provision of information at social
security offices.--Section 1905(p) of the Social Security Act
(42 U.S.C. 1396d(p)), as amended by subsections (a), (b), (c),
and (d) is amended by inserting after paragraph (9) the
following new paragraph:
``(10) The Commissioner of Social Security shall provide, through
local offices of the Social Security Administration--
``(A) for the enrollment under State plans under this title
for appropriate medicare cost-sharing benefits for an
individual who is a qualified medicare beneficiary or is
eligible for benefits under section 1902(a)(10)(E)(iii) through
utilization of the process established under section 1860D-14;
and
``(B) for providing oral and written notice of the
availability of such benefits.''.
(2) Clarifying amendment.--Section 1902(a)(5) of such Act
(42 U.S.C. 1396a(a)(5)) is amended by inserting ``as provided
in section 1905(p)(10),'' after ``except''.
(f) Outstationing of State Eligibility Workers at SSA Field
Offices.--Section 1902(a)(55) of such Act (42 U.S.C. 1396a(a)(55)) is
amended--
(1) in the matter preceding subparagraph (A), by striking
``subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI),
(a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)'' and inserting
``paragraph (10)(A)(i)(IV), (10)(A)(i)(VI), (10)(A)(i)(VII),
(10)(A)(ii)(IX), or (10)(E)''; and
(2) in subparagraph (A), by striking ``1905(1)(2)(B)'' and
inserting ``1905(l)(2)(B), and in the case of applications of
individuals for medical assistance under paragraph (10)(E), at
locations that include field offices of the Social Security
Administration''.
SEC. 5. ELIMINATION OF ASSET TEST.
(a) In General.--Section 1905(p)(1) of the Social Security Act (42
U.S.C. 1396d(p)(1)) is amended--
(1) by adding ``and'' at the end of subparagraph (A);
(2) by striking ``, and'' at the end of subparagraph (B)
and inserting a period; and
(3) by striking subparagraph (C).
(b) Effective Date.--The amendments made by subsection (a) shall
apply to eligibility determinations for medicare cost-sharing furnished
for periods beginning on or after January 1, 2006.
SEC. 6. IMPROVING ASSISTANCE WITH OUT-OF-POCKET COSTS.
(a) Eliminating Application of Estate Recovery Provisions.--Section
1917(b)(1)(B)(ii) of the Social Security Act (42 U.S.C.
1396p(b)(1)(B)(ii)) is amended by inserting ``(but not including
medical assistance for medicare cost-sharing or for benefits described
in section 1902(a)(10)(E))'' before the period at the end.
(b) Providing for 3 Months Retroactive Eligibility.--
(1) In general.--Section 1905(a) of such Act (42 U.S.C.
1396d(a)) is amended, in the matter preceding paragraph (1), by
striking ``described in subsection (p)(1), if provided after
the month'' and inserting ``described in subsection (p)(1), if
provided in or after the third month before the month''.
(2) Conforming amendments.--(A) The first sentence of
section 1902(e)(8) of such Act (42 U.S.C. 1396a(e)(8)), as
amended by section 4(c)(2), is amended by striking ``(8)'' and
the first sentence.
(B) Section 1848(g)(3) of such Act (42 U.S.C. 1395w-
4(g)(3)) is amended by adding at the end the following new
subparagraph:
``(C) Treatment of retroactive eligibility.--In the
case of an individual who is determined to be eligible
for medical assistance described in subparagraph (A)
retroactively, the Secretary shall provide a process
whereby claims submitted for services furnished during
the period of retroactive eligibility which were not
submitted in accordance with such subparagraph are
resubmitted and re-processed in accordance with such
subparagraph.''.
SEC. 7. IMPROVING PROGRAM INFORMATION AND COORDINATION WITH STATE,
LOCAL, AND OTHER PARTNERS.
(a) Data Match Demonstration Project.--
(1) In general.--The Secretary of Health and Human Services
(acting through the Administrator of the Centers for Medicare &
Medicaid Services), the Secretary of the Treasury, and the
Commissioner of Social Security shall enter into an arrangement
under which a demonstration is conducted, consistent with this
subsection, for the exchange between the Centers for Medicare &
Medicaid Services, the Internal Revenue Service, and the Social
Security Administration of information in order to identity
individuals who are medicare beneficiaries and who, based on
data from the Internal Revenue Service (such as their not
filing tax returns or other appropriate filters) are likely to
be--
(A) a qualified medicare beneficiary (as defined in
1905(p)(1) of the Social Security Act (42 U.S.C.
1396d(p)(1)));
(B) otherwise eligible for medical assistance under
section 1902(a)(10)(E) of the Social Security Act (42
U.S.C. 1396a(a)(10)(E)); or
(C) entitled to a premium or cost-sharing subsidy
under section 1860D-14 of such Act (42 U.S.C. 1395w-
114).
(2) Limitation on use of information.--Notwithstanding any
other provision of law, specific information on income or
related matters exchanged under paragraph (1) may be disclosed
only as required to carry out subsection (b) and for related
Federal and State outreach efforts.
(3) Period.--The project under this subsection shall be for
an initial period of 3 years and may be extended for additional
periods (not to exceed 3 years each) after such an extension is
recommended in a report under subsection (d).
(b) State Demonstration Grants.--
(1) In general.--The Secretary of Health and Human Services
shall enter into a demonstration project with States (as
defined for purposes of title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) to provide funds to States to use
information identified under subsection (a), and other
appropriate information, in order to do ex parte determinations
or utilize other methods for identifying and enrolling
individuals who are potentially--
(A) a qualified medicare beneficiary (as defined in
1905(p)(1) of the Social Security Act (42 U.S.C.
1396d(p)(1)));
(B) otherwise eligible for medical assistance
described in section 1902(a)(10)(E) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(E)); or
(C) entitled to a premium or cost-sharing subsidy
under section 1860D-14 of such Act (42 U.S.C. 1395w-
114).
(2) Authorization of appropriations.--There are authorized
to be appropriated such sums as may be necessary to the
Secretary of Health and Human Services for the purpose of
making grants under this subsection.
(c) Additional CMS Funding for Outreach and Enrollment Projects.--
There are hereby appropriated, out of any funds in the Treasury not
otherwise appropriated, to the Secretary of Health and Human Services
through the Administrator of the Centers for Medicare & Medicaid
Services, $100,000,000 which shall be used only for the purpose of
providing grants to States to fund projects to improve outreach and
increase enrollment in Medicare Savings Programs and low-income subsidy
programs under section 1860D-14 of such Act (42 U.S.C. 1395w-114). Such
projects may include cooperative grants and contracts with community
groups and other groups (such as the Department of Veterans' Affairs
and the Indian Health Service) to assist in the enrollment of eligible
individuals.
(d) Reports.--The Secretary of Health and Human Services shall
submit to Congress periodic reports on the projects conducted under
this section. Such reports shall include such recommendations for
extension of such projects, and changes in laws based on such projects,
as the Secretary deems appropriate.
SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENEFICIARIES.
(a) SSA Notice.--
(1) In general.--At the time that the Commissioner of
Social Security sends a notice to individuals that they have
been determined to be eligible for benefits under part A or B
of title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq., 1395j et seq.), the Commissioner shall send a notice and
application for benefits under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) to those individuals the
Commissioner identifies as being likely to be--
(A) a qualified medicare beneficiary (as defined in
1905(p)(1) of the Social Security Act (42 U.S.C.
1396d(p)(1)));
(B) eligible for benefits under clause (i), (ii),
or (iii) of section 1902(a)(10)(E) of such Act (42
U.S.C. 1396a(a)(10)(E)); or
(C) entitled to a premium or cost-sharing subsidy
under section 1860D-14 of such Act (42 U.S.C. 1395w-
114).
(2) Additional information required.--Such notice and
application shall be accompanied by information on how to
submit such an application and where to obtain more information
(including answers to questions) on the application process.
(b) Including Information in Medicare & You Handbook.--The
Secretary of Health and Human Services shall include in the annual
handbook distributed under section 1804(a) of the Social Security Act
(42 U.S.C. 1395b-2(a)) information on the availability of Medicare
Savings Programs and a toll-free telephone number that medicare
beneficiaries may use to obtain additional information about the
program.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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